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Wisconsin DepartrnentofIndus", SOIL AND SITE EVALUATION REPORT Page Iof� <br /> Labtx and Human Relations <br /> Division of Safety&Buildings in accord with ILHR 83.05,Wis.Adm. Code <br /> COUNT <br /> Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but I.D.# <br /> not limited to vertical and horizontal reference point(BM),direction and%of slope,scale or PARCE .# <br /> dimensioned, north arrow,and location and distance to nearest road. b <br /> APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIE EDB DATE <br /> PROPERTYOWNER: PROPERTY LOCATION _7a0 <br /> Teff SU IJ ✓2 51k) 1/4SE 1/4,5 1(0T 3g ,N,R Ig E(or Wi� <br /> PROPERTY OWNERS MAILING ADDRESS LOT# BLOCK# I SUED.NAME 0 1 CSM# <br /> CITY,STATE ZIP CODE PHONE NUMBER []CITY ❑VI OWN NEAREST <br /> G b 5'�S (715 GS - ; jer Sf . 70 <br /> th New Construction Use j] Residential/Number of bedrooms 1�p [ ] Addition to xisting building <br /> I ] Replacement [ ] Public or commercial describe <br /> Code derived daily How 300 gpd Recommended design loading rate •5 bed,gpd/ 2 • trench,gpd/ft2 <br /> Absorption area required /" bed,ft2 500 trench,ft2 Maximum design loading rate - S bed,gpd/It2 trench,gpd/112 <br /> Recommended infiltration surface elevation(s) q-7.1-7 -77,& ( It (as referred to s4e plan ben&mark) <br /> Additional design/site considerations S. /9 / IbSexu boriqlC-1-2450 ' ) <br /> Parent material a t060 I pr i-p+ Flood plain eleva n,if applicable N/9 ft <br /> S=Suitable for system CONVEMIAL ND N- ROUND PRESSURE T-GRADE TEM IN FILL HOLDINGJANK <br /> U=Unsuitable fors stem ❑S U IS ❑U S ❑U SElul AS ❑U ❑S WU <br /> SOIL DESCRIPTION REPORT <br /> Depth Dominant Color Mottles Texture Structure Consistence BoLnlay Roots GPD/ft <br /> Boring# Horizon in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. I Bed Trtaxfl <br /> 31.;1 —_-- S Trn5bk rho 65 3-Fw • 7 <br /> ;? I]-u 7.sy u( — - 5 sbk my 3f� 7 ,8 <br /> Ground 3 ala s$ 7,5-14(z5ly z— Cr)5 m5bk m✓ S • lP <br /> ft. 5'3-70 �, selev. 4 s g F�5 m r –�— f ,S <br /> Depth to <br /> limiting <br /> fa r <br /> Remarks: <br /> Boring# I S <br /> CZ <br /> Ground 3 58 -75 4ly S P-SI? <br /> elev. <br /> Depth to <br /> limiting <br /> fac <br /> Remarks: r 0\ <br /> CST Name:—Please Print r �i l-h , ��n cr h°^e: 7 �-�ps3-a 3 a q <br /> Address: a oZ (\. Cjrek Jed- r T 97 <br /> Signature: Date: CST Number"Aw <br />